Healthcare Provider Details

I. General information

NPI: 1376695262
Provider Name (Legal Business Name): ERICA IRENE THOMPSON PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
CAMBRIDGE WI
53523-9141
US

IV. Provider business mailing address

W9039 HARTWIG RD
CAMBRIDGE WI
53523-9534
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-3231
  • Fax: 608-423-7128
Mailing address:
  • Phone: 608-423-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14635
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: